These included the release of a contracture band across the perineum, repair of a single case of anal stenosis, and multiple small skin grafts to the lower limbs to ensure complete skin cover before reversal of the colostomy.

Appropriate reasons for referral include any suggestion of persistent anal stenosis, a palpable presacral mass, abnormal position of the anal opening, and Hirschsprung's disease, which can cause chronic constipation with or without abdominal distention.

Long term complications with 3 to 6 months postoperatively in both groups revealed the absence of anal stenosis, acute anal fissure, faecal incontinence and recurrence however, further follow up is needed.

The study which conflicted in results regarding post operative stricture formation was conducted at Jinnah Hospital, Lahore, according to which the incidence of anal stenosis was less in closed as compared to open haemorrhoidectomy12.

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